Why are so many nursing homes so dangerously understaffed?

Dean Lerner

The mostly for-profit nursing home industry, funded by untold billions of taxpayer dollars, has nearly once again succeeded in undermining the health, safety, welfare and rights of our Nation’s nursing home residents.  The Centers for Medicare & Medicaid Services has promulgated an interim final Rule (FR 55687) that repeals its own 2024 rule establishing minimum staffing standards.  

Staffing, no one will be surprised, is the single most important factor in nursing home care, and is known to protect and improve the lives of over 1.24 million residents who make their home in Medicare/Medicaid certified facilities. Staffing is also known to be insufficient/grossly insufficient in an unacceptable number of homes. Research shows a direct correlation between poor staffing and poor care. Too, neglect and abuse are all too common in understaffed facilities.

After its own 2024 original detailed evaluation and study, publicly commented on by over 46,500 groups and individuals, thoroughly researched and providing for certain exceptions and delays, the original Minimum Staffing Standards Rule was finalized.  The mostly for-profit industry did its best to upend the 2024 rule, but when it failed in this effort, it launched multiple attacks on different fronts: legal, political and otherwise. Ultimately, the Trump Administration’s “One Big Beautiful Bill” placed a 10 year moratorium on the rule.  

While the Trump Administration initially defended legal attacks on the rule in Iowa and Texas, it subsequently ceased this defense. Outrageously, our own Iowa Attorney General led the Iowa lawsuit against the rule on behalf of Republican Attorneys General. Gov. Reynolds, too, made her opposition to minimum staffing standards well known.  

How could this be, one might ask, that every elected official wouldn’t be100% supportive of a rule that everyone knows will save and improve lives? Given that CMS is the sole statutorily bound federal agency responsible for ensuring the health, safety, welfare and rights of residents, what could possibly have motivated CMS to intentionally contradict everything it stands for?      

The Jan. 27 New York Times article, “After Donations, Trump Administration Revoked Rule Requiring More Nursing Home Staff” (https://www.nytimes.com/2026/01/27/us/politics/after-donations-trump-administration-revoked-rule-requiring-more-nursing-home-staff.html?unlocked_article_code=1.HlA.oVRq.WNeJCN7Taz_X&smid=nytcore-ios-share&referringSource=articleShare) may answer this question.  In this same regard, Iowa nursing home campaign contributions to our Republican elected officials have been widely reported.

It appears as if the CMS revocation of its 2024 rule may end with another industry victory. The final comment period regarding the revocation ended Feb. 2. Public comments can be found at https://www.regulations.gov/document/CMS-2023-0144-46539/comment?postedDateFrom=2025-11-04&postedDateTo=2026-02-01.  

So, is this over? What can be done now?

We can begin by demanding that the American Health Care Association and other powerful nursing home lobbying entities (including the Iowa Health Care Association) are no longer funded by taxpayer dollars. The 2024 AHCA Form 990 tax submission lists over $24 million in revenue (https://projects.propublica.org/nonprofits/organizations/530260105/202533099349302083/full). The 2024 IHCA Form 990 lists nearly $2.5 million in revenue (https://projects.propublica.org/nonprofits/organizations/426067903/202511619349300231/full). The salaries and benefits of the executives of these associations are obscene. Don’t take my word for it, look at them!  Talk about waste, fraud and abuse!

Why, we might ask, would taxpayer dollars be allowed to fund the AHCA and the IHCA, whose agendas focus on more money for their member homes, and less oversight of them?  Why would taxpayer dollars be allowed to fund any Association whose efforts fly in the face of resident health, safety, welfare and rights?  

Is it over? NO, it’s not over, not by a long shot.  

Every upcoming election has the potential to reverse the damage done to our loved ones, our families, our friends, our neighbors and every single vulnerable resident.

You may not be impacted by what is knowingly and intentionally happening to our vulnerable seniors and disability community yet, but chances are good that you will be the victim one day unless you vote accordingly.  

Dean Lerner is a graduate of Grinnell College and Drake University Law School. He served for nearly 30 years as an Iowa Assistant Attorney General, Chief Deputy Secretary of State, then Deputy/Director of the Iowa Department of Inspections & Appeals. He then worked for the CMS Director of the Division of Nursing Homes and the United States Attorney for the Northern District of Iowa.